RESUMO
The wetting ability of water and of some biological liquids was measured on different biocompatible surfaces with and without different colloidal metals. Insoluble nanoparticles disperse in biological tissues enhance some properties, such as the interface adhesion between two surfaces, the X-ray contrast of medical images and the absorbed dose during radiotherapy treatments. The introduction of nanoparticles in the liquids generally improves the wetting ability and changes other properties of the solution, due to the different distribution of the adhesion forces, to the nature, morphology and concentration of the added nanoparticles. An investigation on the contact angle of the liquid drops, physiological liquids, including the human blood, placed on different substrates (polymers, ceramics and metals) with and without the use of metallic nanoparticles is presented, evaluated and discussed.
Assuntos
Materiais Biocompatíveis/química , Nanopartículas Metálicas/química , Propriedades de Superfície , Molhabilidade , Sangue , Cerâmica/química , Humanos , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão , Polímeros/química , Polimetil Metacrilato/química , Silício/química , Dióxido de Silício/química , Titânio/química , Água , Raios XRESUMO
CONTEXT: Bariatric surgery is common and may be associated with deleterious effects on the skeleton. OBJECTIVE: Our objective was to assess bone metabolism and bone mineral density (BMD) after Roux-en-Y gastric bypass. DESIGN AND SETTING: We conducted a 1-yr prospective longitudinal study at a university hospital bariatric surgery practice and metabolic bone disease unit. PARTICIPANTS: Participants included 23 obese (mean body mass index 47 kg/m(2)) men and women, aged 20-64 yr. MAIN OUTCOME MEASURES: Serum PTH, 25-hydroxyvitamin D, osteocalcin, and urinary N-telopeptide, and BMD were assessed. RESULTS: Patients lost 45 +/- 2 kg 1 yr postoperatively (P < 0.01). PTH increased early (3 months, 43-50 pg/ml; P < 0.001) and urinary calcium dropped (161-92 mg/24 h; P < 0.01), despite doubling of calcium intake (1318-2488 mg/d; P < 0.001). Serum 25-hydroxyvitamin D concentrations were unchanged (23-26 ng/ml), although vitamin D intake increased by 260% (658 IU/d at baseline to 1698 IU/d at 12 months; P < 0.05). Markers of bone remodeling rose (P < 0.01 for both urinary N-telopeptide and osteocalcin), whereas BMD decreased at the femoral neck (9.2%, P < 0.005) and at the total hip (8.0%, P < 0.005). These declines were strongly associated with the extent of weight loss (femoral neck: r = 0.90, P < 0.0001; and total hip: r = 0.65, P = 0.02). Lumbar spine and distal radius sites did not change. CONCLUSIONS: After Roux-en-Y gastric bypass, there was evidence of calcium and vitamin D malabsorption. Bone turnover increased, and hip bone density rapidly declined. The decline in hip BMD was strongly associated with weight loss itself. Vigilance for nutritional deficiencies and bone loss in patients both before and after bariatric surgery is crucial.
Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/etiologia , Derivação Gástrica/efeitos adversos , Quadril , Redução de Peso/fisiologia , Adulto , Densidade Óssea/fisiologia , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/patologia , Doenças Ósseas Metabólicas/prevenção & controle , Citrato de Cálcio/uso terapêutico , Feminino , Seguimentos , Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Hormônio Paratireóideo/sangue , Ossos Pélvicos/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Vitamina D/uso terapêuticoRESUMO
BACKGROUND: Tamoxifen, for many years the 'gold standard' in the adjuvant setting for the management of endocrine sensitive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy due to the development of resistance. This provided the rationale for a switching trial with anastrozole, the updated results of which are reported here. PATIENTS AND METHODS: This trial investigated the efficacy of switching to anastrozole for women already receiving tamoxifen. After 2-3 years of tamoxifen treatment, postmenopausal, node-positive, ER-positive patients were randomized to receive either anastrozole 1 mg/day or to continue tamoxifen, 20 mg/day, giving a total duration of 5-years treatment. The primary end point was disease-free survival and secondary endpoints were event-free survival, overall survival and safety. RESULTS: A total of 448 patients were enrolled. At a median follow-up time of 64 months (range 12-93), 63 events had been reported in the tamoxifen group compared with 39 in the anastrozole group [HR 0.57 (95% CI 0.38-0.85) P = 0.005]. Relapse-free and overall survival were also longer in the anastrozole group [HR 0.56 (95% CI 0.35-0.89) P = 0.01 and 0.56 (95% CI 0.28-1.15) P = 0.1]. However, the latter difference was not statistically significant. Overall more patients in the anastrozole group experienced at least one adverse event (209 versus 151: P = 0.000). However, numbers of patients experiencing serious adverse events were comparable (37 versus 40, respectively: P = 0.7). CONCLUSIONS: Switching to anastrozole after the first 2-3 years of treatment was confirmed to improve event-free and relapse-free survival of postmenopausal, node-positive, ER-positive early breast cancer patients already receiving adjuvant tamoxifen.
Assuntos
Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Nitrilas/uso terapêutico , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/uso terapêutico , Triazóis/uso terapêutico , Anastrozol , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/metabolismo , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Nitrilas/efeitos adversos , Pós-Menopausa , Receptores de Estrogênio/biossíntese , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Tamoxifeno/efeitos adversos , Triazóis/efeitos adversosRESUMO
Focal segmental glomerulosclerosis (FSGS) is a renal disease characterized by sclerotic segmentary lesions, involving a few glomeruli. Male-female ratio is >1 and, in the majority of cases, the patients are aged between 25 to 35 years. The clinical picture is similar to a nephrotic syndrome with non-selective proteinuria poorly sensitive to steroids and often associated with microhematuria. The etiology is still unknown, even in a prevalence in drug addicts, patients with AIDS and subjects with recurrent urological infections with vesico-ureteral reflux was observed. Recent reports showed that chronic infection Hepatitis C Virus (HCV)-related may be associate with or responsible for onset of some syndrome involving the kidney but not the liver. We report the case of a young woman with HCV-Ab positive chronic hepatitis that, during the disease, showed clinical findings of renal involvement, histologically related to a FSGS. We administered to her alpha-IFN at doses of 3 Mega Units thrice-a-week for six months. Serum HCV-RNA, proteinuria and hematuria disappeared simultaneously after the treatment. We underline that the lack of finding of HCV antigens or HCV-RNA in glomerular lesions (as occurred in our patient) does not rule out the virus role in pathogenesis of immunological nephritis. The recovery of our patient as well as the disappearance of proteinuria and hematuria during IFNalpha treatment may be further evidence that FSGS and chronic hepatitis HCV-related are not associated by chance. Further observations and perfectioning of diagnostic techniques are required to clarify the pathogenetic relationship between HCV and renal immunological syndromes.
Assuntos
Glomerulosclerose Segmentar e Focal/virologia , Hepatite C Crônica/complicações , Adulto , Antivirais/uso terapêutico , Feminino , Hepatite C Crônica/tratamento farmacológico , Humanos , Interferon-alfa/uso terapêuticoRESUMO
Thyroid carcinosarcoma is a rare and aggressive thyroid tumor. Histological examination of a tumor showed the characteristic of epithelial carcinoma and mesenchymal differentiation. We retrospectively analyzed the course of the patient and reviewed the literature in which only 19 other cases are described. Carcinosarcoma of the thyroid is a very aggressive tumor with a clinical course similar to anaplastic thyroid carcinoma. Survival is very short despite aggressive multimodal treatment.
Assuntos
Carcinossarcoma/patologia , Neoplasias da Glândula Tireoide/patologia , Antibióticos Antineoplásicos/uso terapêutico , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/radioterapia , Carcinossarcoma/secundário , Carcinossarcoma/cirurgia , Quimioterapia Adjuvante , Terapia Combinada , Epirubicina/uso terapêutico , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/secundário , Excisão de Linfonodo , Pessoa de Meia-Idade , Radioterapia Adjuvante , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Castleman's disease is a rare lymph node pathology characterized by angiofollicular hyperplasia. There are two forms of the disease: localized and systemic, with different features, symptoms and prognosis. Three are the histological types of disease: plasma cell, hyaline-vascular and mixed variants. We report the case of a 65-year-old female affected by localized plasma cell variant of Castleman's disease. The singularity of our case lies in its localization on the breast and monoclonal plasma cell proliferation inside the nodule.
Assuntos
Hiperplasia do Linfonodo Gigante/patologia , Idoso , Doenças Mamárias/imunologia , Doenças Mamárias/patologia , Hiperplasia do Linfonodo Gigante/imunologia , Feminino , Humanos , Imunofenotipagem , Plasmócitos/imunologia , Plasmócitos/patologiaRESUMO
OBJECTIVE: Our study was designed to evaluate the role of omega-3 fatty acids (OFAs) in reducing serum triglyceride levels in patients with chronic hepatitis C receiving treatment with interferon-alpha (IFNalpha). DESIGN: 52 patients (23 males, 29 females) with chronic hepatitis C were randomly assigned to nonblind treatment with IFNalpha 3 million units (MU) three times weekly alone (group A) or in combination with OFAs 3 g/day for 6 months (group B). RESULTS: Hepatitis C virus (HCV) RNA serum levels decreased significantly in both groups compared with baseline, but there was no significant difference in HCV RNA levels between the 2 groups. At the end of treatment there was a statistically significant difference in ALT levels between patients in group A and in group B (72.15 vs 50.05 IU/L; p = 0.01). A statistically significant increase in triglyceride levels occurred in group A during treatment (p = 0.03 vs baseline). In contrast, a statistically significant decrease in triglyceride serum levels occurred in group B (p = 0.001 vs baseline). CONCLUSION: Concurrent administration of OFAs reversed IFNalpha-induced hypertriglyceridaemia in patients with chronic hepatitis C.
RESUMO
The best results in terms of clinical remission in chronic hepatitis C are achieved by interferon (IFN)-alpha treatment. We studied 255 patients affected by chronic hepatitis C infection (HCV) and divided into 3 groups. A different IFN-alpha therapeutic schedule was adopted in each group: A) 3 million units (MU) three times per week for 6 months; B) 3 MU three times per week for 12 months; C) 6 MU three times per week for 6 months. A sustained biohumoural and virological remission was observed in only 14.5% of the patients included in group A, in 21.6% of the patients included in group B and in 8% of the patients included in group C. The adoption of more aggressive therapeutic regimens did not offer an improvement in response or patient compliance. At present, the long term efficacy of treatment may be evaluated on the basis of both biochemical and virological data.
Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/terapia , Interferon-alfa/administração & dosagem , Adolescente , Adulto , Antivirais/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Interferon-alfa/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
Eosinophilic gastroenteritis is a rare disease of unknown aetiology characterized by eosinophilic infiltration of the gastrointestinal wall and increased peripheral blood eosinophilia. The frequent finding of concomitant extradigestive involvement calls for differential diagnosis to distinguish some multisystemic pathologies, such as connective tissue disease. We recently treated a young woman affected by eosinophilic infiltration of the small and large intestine which spread to other organs. Tests ruled out allergic or parasitic aetiopathogenesis of the disease. The clinical, biological and evolutive findings suggest that eosinophilic gastroenteritis may evolve into idiopathic hypereosinophilic syndrome.
Assuntos
Gastroenterite/complicações , Síndrome Hipereosinofílica/complicações , Adolescente , Biópsia , Doenças do Tecido Conjuntivo/diagnóstico , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Feminino , Seguimentos , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Síndrome Hipereosinofílica/diagnóstico , Síndrome Hipereosinofílica/tratamento farmacológico , Intestino Grosso/diagnóstico por imagem , Intestino Grosso/patologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
In elderly subjects (above 65 years), cardio- and cerebrovascular diseases are known to contribute to the death rate. Serum lipoprotein(a) = Lp(a), a low density lipoprotein, is involved in the atherogenic processes, as confirmed by several clinical trials. We evaluated serum Lp(a) levels in a group of centenarians (15 females and 7 males, mean age 102.81 +/- 2.5 years) compared to 25 healthy control subjects (10 males and 15 females, mean age 51.12 +/- 15.34 years). In all subjects Lp(a) serum levels were determined by ELISA method (EIA mod. 2550 reader). Statistical analysis of the results was performed by using the Student's t test. In centenarians the mean Lp(a) level increased (39.6 +/- 23.53 mg/dl) compared to that of the control group (16.78 +/- 16.24 mg/dl) (p < 0.005). The elevated Lp(a) values observed in centenarians may be attributed to the presence of low molecular weight lipoprotein isoforms which are known to be associated with cardio-cerebrovascular risk. Therefore, it seems that elevated Lp(a) levels alone are not risk factors for the onset of acute acute vascular accidents and do not influence longevity.
RESUMO
The sense of smell was studied in a group of centenarians from Eastern Sicily, displaying a mini mental state examination score larger than 19. Analysis of the data demonstrated that centenarians retain the capacity to perceive olfactory stimuli. However, as compared to the results obtained in groups of young and elderly subjects, a statistically significant quantitative reduction (p < 0.001) in the sense of smell was revealed in the centenarians.
RESUMO
Over the last few years, lipoprotein(a) [Lp(a)] levels have been investigated because clinical studies have related it to increased cardiovascular and cerebrovascular risk. Although it is known that serum Lp(a) concentrations are controlled genetically, little is known about its metabolism. We studied changes in the lipid profile and Lp(a) values in 57 patients (34 males and 23 females) affected by cirrhosis of the liver subdivided into Child's classes in order to assess whether this lipoprotein is sensitive to reduced liver protein synthesis. The patients presented with low total cholesterol, normal HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c), triglycerides, apoprotein A1 (Apo-A1) and apoprotein B100 (Apo-B100) concentrations, while Lp(a) concentrations seemed elevated. Grouping the patients into Child's classes revealed that all the lipid parameters investigated reduced as the disease progressed. Lp(a) reduced significantly between Child's Classes I and II and seems to be correlated with the severity of cirrhosis and the clinical worsening of the patients' conditions. These findings suggest that Lp(a) is not only an index of atherosclerosis risk, but also plays a role in monitoring liver functions.
Assuntos
Lipoproteína(a)/sangue , Cirrose Hepática/metabolismo , Índice de Gravidade de Doença , Idoso , Biomarcadores/sangue , Feminino , Humanos , Cirrose Hepática/classificação , Cirrose Hepática/etiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Active chronic hepatitis may be associated with various immunologic diseases. In the Mediterranean area and to a lesser extent elsewhere, hepatitis C virus, has often been detected in patients affected by mixed cryoglobulinemia, membranoproliferative glomerulonephritis, polyarteritis nodosa autoimmune type 2b hepatitis, Hashimoto's disease, Sjögren's syndrome and lichen ruber planus. These findings should not be considered fortuitous due to the elevated prevalence of autoantibodies and immunologic abnormalities observed in hepatitis C patients compared with subjects presenting other liver diseases. The pathogenetic evaluation of the association between these immunologic diseases and chronic hepatitis C has led us to suggest that diverse virus C and host induced factors may play a fundamental role in determining these immunologic diseases.